The Public's Health

The Robert Wood Johnson Foundation describes its ambitious annual attempt to rate the health of counties in every statebased on analysis of voluminous data as an effort to prod communities to make things better, although the rankings have a lot to do with conditions over which they have limited control: high income and level of education, for example, are strongly linked to health (Chester County is second out of 67 Pennsylvania counties; Philadelphia is 67th).

The just-released 2014 report has two sets of rankings. Health Outcomes are based on measures of life expectancy and quality of life. Health Factors – what lead to those outcomes – are based on four broad categories: health behaviors (30 percent) such as tobacco use, diet and exercise, alcohol and drug use, and sexual activity; clinical care (20 percent), which includes both access to and quality of care; social and economic factors (40 percent) like education, employment, income, family and social support, and community safety; and, physical environment (10 percent), which incorporates air and water quality, housing and transit.

To really appreciate the ratings, dig into the underlying data on teen births, adult obesity, access to dental care, diabetes and mammography screening, unemployment, and deaths from injuries, among other things. All these factors, and the resulting health of the population, add up to an excellent summary of the elements constituting public health and how we measure it.

Because of variations in data collection from state to state, the rankings are not intended to be meaningful across state lines. Of New Jersey's 21 counties, the three closest to Philadelphia come out more or less in the middle on Health Outcomes: Burlington County is 11th, Gloucester 13th, and Camden is 17th; the Health Factors that play a role in those outcomes are also in the middle.

A quick glance at the data from the city reveals why: smoking rates, for example, are high. So is obesity. Sixteen percent of residents are uninsured. Child poverty rates are also high and, not surprisingly, unemployment. You can’t tackle all of these issues at once or on your own; they require individual, family, community, city, state, and federal action. In the short run, Philadelphia residents can find information about health services here. For health insurance, go to www.healthcare.gov or call 1-800-318-2596. Keep in mind you must start the process by March 31 to get subsidized coverage under Obamacare. Despite all the vitriol, a lot of people are interested in this coverage. A tip: the website is often shut down for uploading between 1 a.m. and 5 a.m. so it is best not to try then.

The rankings aren't presented as criticism of poorly-performing communities; they are meant to encourage them to take action. The report links to a large number of scientifically-supported studies about effective interventions. It connects, for example, me, to information about cell-phone-based tobacco cessation interventions, breastfeeding programs, and activity programs for older adults. It includes policy strategies, inspiring stories, and information about community grants, as well.

Everyone, of course, likes to see how their county stacks up against the competition. Take a step back, however, and use this report to understand how it got there and where it might be able to go.